Individuals coping with substance use, eating challenges, nicotine dependence, and/or are struggling with changing adverse health behaviors are all well-suited for this group
Finding Ease in a Stressful World 3:00 - 4:30 p.m. in Group Room A (rm 1193)
Individuals dealing with grief, loss, and bereavement
We address loss of loved ones, but we also focus on anticipatory grief; loss related to changes in health status; and complicated grief
MHC - Held at Miller Wellness Center (MWC)
Living Well with Difficult Emotions: Tuesdays 5:30-7:00 p.m.
Individuals coping with depression, bipolar disorders, overwhelming emotions, including anger, sadness, grief
Seeking Safety - From Trauma to Resilience: Wednesdays 10:30 - 12:00 p.m.
Individuals who have experienced overwhelming or traumatic life events, PTSD, co-occurring substance use disorders, such as alcohol use, polysubstance use, or opiate addiction, etc.
Finding Ease in a Stressful World: Thursdays 5:30-7:00 p.m.
NRC (Groups on break until October 2014 - NRC pts are welcome to attend WCHC groups in the interim)
Stress Management Group: Tuesdays 3:00 -4:30 p.m.
Individuals coping with psychosocial stressors (relationship, financial, or other), anxiety, or worry
Individuals interested in stress management techniques, relaxation strategies, or assertive communication skills
Mood Group: Wednesdays 9:30-11:00 a.m.
Individuals coping with mood management challenges, specifically managing depression in everyday life.
Who:
Michael Changaris, PsyD (925) 335-7435 at Martinez Health Center (Training Coordinator and Groups Facilitator) @ MHC/MWC Tuesdays-Wednesday, Thursdays evenings, Friday; @ WCHC Mondays, Thursdays, and Tuesday afternoons
Emma Hiatt Wilson, PhD (510) 231-9572, ext 4 at West County Health Center (West County Site Liaison) @ WCHC Monday-Thursday
Franca Niameh, PsyD (510) 231-1371 at North Richmond Center for Health (North Richmond Site Liaison) @ NRC Monday-Thursday
What: Evidenced-based depression care for patients over 60
Eligibility:
Contra Costa County Medi-Cal
Medicare/Medi-Cal
Uninsured/ Basic Health Care
NO MEDICARE ONLY - Patients ineligible for IMPACT will be screened and redirected to the appropriate resource by the Depression Care Manager.
Where: Martinez, Richmond, Pittsburg, Brentwood, North Richmond
How to refer:
Call Depression Care Manager at your clinic to leave a confidential voice mail with patient's name, MRN and DOB or to see if available to meet patient on the spot.
Send an IN BASKET message via CCLINK to regional Depression Care Manager to your clinic.
CHART CHECK patient's chart to regional Depression Care Manager via CCLINK.
Who:
Brenda Luna, LCSW (925) 431-2751 at Brentwood and Pittsburg Health Centers (serving East County)
@ PHC Mondays and Thursdays, @ BHC 3rd Friday of each month
Amanda Dold, MFT (925) 521-5635, Cell (925) 348-1021 at Martinez Health Center (serving Central County)
@ MHC on Thursdays
Albert Fam, LCSW (510) 531-9570 at West County Health Center (serving West County)
@ WCHC Monday-Friday
Relevant EBM articles: Unutzer et al JAMA 288 (22):2836-2845 Dec. 11 2002
(includes Autism, Aspergers, Pervasive Developmental Disorder) Prevelance - (?) 1 in 140 , Boys 4:1
Dx observations - Listen to parent carefully, Altered social engagement (eg won't play peek-a-boo), Speech delay or very odd use of language (eg echolalia), Abnormal-intense focused interests and repetitive behaviors (eg hand flapping, rigid routines )
Family Practice role - coordinating care for family, Referral to Child Development clinic (x5270 - SW Krista Peterson ), who will do comprehensive DDx (fragile X, etc)
Parent Information - www.autismspeaks.org has a neat video comparing normal and autistic child, references, numbers, etc
Counseling Resources:
Crisis and counseling/therapy referrals, as well as other community resources (STAND, Caregiver Support, Senior Services, AA/NA), provided by Patty Hennigan, August 2012.
Mental health clinic records:
Per an email from Chris Farnitano, January 2009: "For access to the paper mental health chart, the best way that was suggested [by one of the psychiatrists] was to fax the form for Record Transfer (MR 205) to the mental health clinic in question and they will fax you back the requested information. The relevant fax numbers are as follows:
California has endorsed the discussion of end of life issues to help improve the care provided for people. It is used to encourage doctors to discuss end of life decision making beyond DNR/DNI and advance directive forms.
POLST (Physician ordered life sustaining treatment): PDF forms in multiple languages, to be printed on PINK cardstock.
Dementia:
Certainly, some of the most troubling symptoms for demented patients and their caregivers are insomnia or behavioral problems (agitation, wandering, etc.). Obviously the first issue is their safety, as they may need a higher level of care if behavioral problems place them or others in danger. The medications listed her are obviously in addition to other treatments for the cognitive issues associated with dementia (Aricept, Namenda, etc.) which can also help with behavioral problems. Medications that should be avoided are: benadryl or tricyclic antidepressants (amitriptyline, nortriptyline) due to anticholinergic properties, can cause delirium. Ambien or benzos probably not good for same reason. For antidepressants, Paxil is the most anticholinergic SSRI and Prozac can build up in system because the half-life is very long, and should not be the first choices. One thing to note is that no medications are FDA approved for behavioral symptoms of dementia. However, as we know, they are often necessary. For insomnia, low dose trazodone 25-100 mg qhs or remeron 7.5-15 mg qhs are good options for elderly, very few side effects or drug interactions. For behavioral problems, of course antipsychotics can be helpful, but then there's the issue of increased risk of overall death (i.e. increased incidence of stroke), both older and newer antipsychotics cause this. Nevertheless, when patients' behavior needs to be controlled, low dose Zyprexa (1.25-10 mg daily), Seroquel (12.5-200mg daily) or even Haldol (1-10mg daily) are good choices. Abilify is a reasonable choice and generally less sedating and can be used at doses of 2-15mg daily. Risperidone is ok but has a higher incidence of Extrapyramidal symptoms. SSRIs such as Citalopram or Sertraline can be used as well for depressive symptoms.
Behavioral Health / Psychiatry
Brief Screening History
Wright Institute - Health Coaching
Behaviorist
Table of Contents
@ PHC Mondays and Thursdays, @ BHC 3rd Friday of each month
@ MHC on Thursdays
Depression
- Antidepressant Medications:
- Antidepressant Medication Management chart, Kaiser, 2009
- AHRQ guide to choosing antidepressant
ScreeningGeneralized Anxiety Disorder
Autistic Spectrum Disorders
Counseling Resources:
Crisis and counseling/therapy referrals, as well as other community resources (STAND, Caregiver Support, Senior Services, AA/NA), provided by Patty Hennigan, August 2012.Mental health clinic records:
Per an email from Chris Farnitano, January 2009: "For access to the paper mental health chart, the best way that was suggested [by one of the psychiatrists] was to fax the form for Record Transfer (MR 205) to the mental health clinic in question and they will fax you back the requested information. The relevant fax numbers are as follows:Pittsburg MHC: 925-431-2608
Concord MHC: 925-646-5622
Richmond MHC: 510-231-1261
Richmond Children's Mental Health: 510-374-3857
End of Life Care
California has endorsed the discussion of end of life issues to help improve the care provided for people. It is used to encourage doctors to discuss end of life decision making beyond DNR/DNI and advance directive forms.
POLST (Physician ordered life sustaining treatment): PDF forms in multiple languages, to be printed on PINK cardstock.
Dementia:
Certainly, some of the most troubling symptoms for demented patients and their caregivers are insomnia or behavioral problems (agitation, wandering, etc.). Obviously the first issue is their safety, as they may need a higher level of care if behavioral problems place them or others in danger. The medications listed her are obviously in addition to other treatments for the cognitive issues associated with dementia (Aricept, Namenda, etc.) which can also help with behavioral problems.Medications that should be avoided are: benadryl or tricyclic antidepressants (amitriptyline, nortriptyline) due to anticholinergic properties, can cause delirium. Ambien or benzos probably not good for same reason. For antidepressants, Paxil is the most anticholinergic SSRI and Prozac can build up in system because the half-life is very long, and should not be the first choices.
One thing to note is that no medications are FDA approved for behavioral symptoms of dementia. However, as we know, they are often necessary. For insomnia, low dose trazodone 25-100 mg qhs or remeron 7.5-15 mg qhs are good options for elderly, very few side effects or drug interactions. For behavioral problems, of course antipsychotics can be helpful, but then there's the issue of increased risk of overall death (i.e. increased incidence of stroke), both older and newer antipsychotics cause this. Nevertheless, when patients' behavior needs to be controlled, low dose Zyprexa (1.25-10 mg daily), Seroquel (12.5-200mg daily) or even Haldol (1-10mg daily) are good choices. Abilify is a reasonable choice and generally less sedating and can be used at doses of 2-15mg daily. Risperidone is ok but has a higher incidence of Extrapyramidal symptoms. SSRIs such as Citalopram or Sertraline can be used as well for depressive symptoms.
Bipolar Disorder: